It's 6 30 in the morning. We're in the East Tower
parking garage at Robert Wood Johnson University Hospital.
It's Friday, which is my normal operative day and today we will be doing four operative cases.
Good morning Dr. Lee
How are you?
Three of the cases are minimally invasive cases and one case is a coronary artery bypass.
So COVID has really impacted how we do things every day. Obviously,
we're all wearing masks all day, every day, not only in the operating room.
Some of the contact made after surgery is by phone.
Morning.
Patients in the room.
Once we hook up the patient to the monitors we do what's called a timeout, which is a safety check.
All right, time out.
The timeout process that we do in the operating room comes from the World Health Organization
and it is a means to be very careful and to ensure that we don't make mistakes
This woman is 62 years old she has what's called aortic stenosis. The valve at the top of the heart
called the aortic valve has become very tight over time and as a consequence, her heart has to work
extra hard to try to push blood through that tight valve. When all the blood can't go forward
it starts backing up and it backs up into the lungs and causes shortness of breath. Can also
cause chest pain because the heart's working extra hard. It can also cause lightheadedness
because not enough blood is actually escaping in the heart and going up into the brain.
So what we're doing today is what's called a minimally invasive aortic valve replacement.
So everything else in the heart is in good working order she'll have about
a three-inch incision on her right chest where we go between the ribs
and through there we can get in there to then replace the valve.
Okay you can ventilate both lungs.
It's fairly straightforward case everything went
well as expected. So I'm going to just call the family member.
Hello.
Good morning it's Dr Lee calling from Robert Wood.
Good morning Dr. Lee.
We're all done with surgery. Everything went well. She got the valve replaced
through the small incision on her right side. She's doing okay.
This is great news. Thank you so very much.
All right we'll see you a little later, okay.
Okay, have a good day.
As the surgeon we get a lot of credit. But honestly speaking the operation is 10-15%
of the success of our program. It's all these people. It's everyone in this room,
it's everyone in the ICU, it's everyone on the floor. The care they give - the
attention to detail - all of that is incredibly important to the success.
It is now nine o'clock, we're in the second room.
This gentleman is 74 years old and like the last patient, he has a tight aortic valve.
But in addition to that, because it's sort of been long-standing, the mitral valve is now also
leaking. So he's a very good shape uh 74-year-old gentleman so we're obviously going to go ahead and
fix his heart. We're going to again do this through a small incision on his right side.
We will go in to replace the aortic valve and repair the mitral valve.
So by echo or ultrasound, we can see that the valve is actually... the mitral valve
is actually calcified. So I may need to replace both valves in this circumstance,
but we'll see what it looks like when we get in.
We are a very high volume center and the importance of high volume
is that there are many many studies that show that the more you do
the better you are, and you become a major referral center.
But that does not take away from the personal touches that we
have with our patients and the personal relationships we have with our patients.
How's he doing?
He's good!
Is he?
Yeah, everything went well. Replaced both valves with a small incision on the side.
His heart's otherwise in good shape. He'll be out of the operating room in about 20 minutes.
When you're able to go out and speak to the family and tell them that everything went well
and that their loved one is doing well is always very very rewarding
so that's one of the best parts of the job.
The next patient is a pure mitral valve. So that's the valve in the middle of the heart
and in his case it's leaking quite a bit. Just like all these other
valve issues that we've seen today if this is left alone and not fixed
long term the heart starts to get bigger and weaker, bigger and weaker.
Aortic valve's okay?
This is the main university hospital for the Rutgers Robert Wood Johnson
Medical School. We're all faculty of the medical school and this is where we practice.
We do roughly 1600 hearts per year which is one of the largest programs in the northeast.
One.
And the right.
Right's totaled.
Okay so four.
Okay.
Four bypasses.
We just got in the room with the fourth case which is a coronary artery bypass.
And what we do with bypass surgery it's uh - it's
the one operation today that we're actually doing through a standard approach.
She'll have an incision right down the middle of the chest. We'll take an artery from the
inside of the left chest and some vein from her legs to do the bypasses onto the heart.
We don't touch the blockages, we leave the blockages where they are and we use this artery
and the veins to make detours around the blockages so that blood can get to where it needs to get to.
You guys okay?
Yeah, we're good. Thank you.
Thank you sir. Peace Out.
Thanks everybody.
From here we'll go upstairs
to the ICU. Make some rounds on the patients we operated on earlier today.
We are New Jersey's largest academic medical center.
How you doing?
We do a fair amount of research in cardiac surgery. I have a lab
in addition to clinical research.
He's good to last a few more years?
He's good, yeah. [laughs]
It's an institution that has students, residents, research, education,
and ideal or optimal clinical care that encompasses all the forward-thinking
modalities of treating patients. And we want to be on that forward-thinking innovation.
So that ends our day. It's about 4:10 right now. So we've done all of our cases,
we've seen all of our patients, and I think it's time to go home.